Simple and additive diagnostic modalities for the screening of heart failure with preserved ejection fraction

Abstract

Abstract Background Nearly half of all patients with heart failure (HF) symptoms have an EF that is preserved (HFpEF). The prevalence of HFpEF is rising, with high morbidity, mortality. The diagnosis of HFpEF is particularly challenging. Lung ultrasound (LUS) and left atrial strain are promising screening and diagnostic tools to assess pulmonary congestion and left atrial dysfunction in patients with suspected HFpEF. Aim To evaluate the relationship between patients symptoms, pro-BNP level with LUS and left atrial strain, as well to assess the diagnostic power of B-lines in HFpEF population. Methods 82 consecutive patients (57 women, mean age 70±6 years) with clinical signs of heart failure were prospectively enrolled. Exclusion criteria were: ejection fraction <55%, more than mild mitral and/or aortic valve disease, pulmonary disease, pulmonary arterial hypertension. Within one hour all patients underwent comprehensive echocardiographic evaluation including left atrial strain analysis (peak atrial longitudinal strain-LASr), lung ultrasound assessment of B-lines on the anterolateral and posterior chest wall, and NT-proBNP levels. Results In 45 patients (54%) a significant number of B-lines (≥15) were observed. We found a positive correlation between the number of B-lines and NT-proBNP levels (p<0.0001, r=0.67), left atrial volume (p<0.0001, r=0.45), and LASr (p<0.005, r=−0.4). We also found week correlation between the number of B-lines and E/e' ratio (p<0.003, r=0.3), and between E/e' ratio and NT-proBNP level (p<0.05, r=0.2). We also assessed the diagnostic ability of B-lines to predict markedly elevated pro-BNP level (≥125pg/ml), AUC was 0.85, with specificity of 64% and sensitivity of 85% (Figure 1). The number of B lines also correlated with the H2FPEF score (p<0.001, r=0.4). Conclusion LUS is a simple, feasible tool to detect pulmonary congestion in HFpEF and it has an adequate diagnostic power to predict elevated NTpro-BNP level. LASr is promising too, which better reflects pulmonary congestion and elevated NT-proBNP values than the conventional echocardiographic parameters. Figure 1. ROC curve Blines predict high NTproBNP Funding Acknowledgement Type of funding source: None